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Photodynamic Therapy

SUMMARY AND KEY FEATURES Identify the indications and contraindications PDT. Learn the approved PDT protocols for each cutaneous condition. Recognize pre and postoperative preparations, side effects and complications. Become familiar with off-label PDT applications. Introduction Photodynamic therapy (PDT) involves the application of a photosensitizer, a light-absorbing compound, which accumulates in a subset of cells or tissues, followed by illumination with specified wavelengths, which triggers a reaction…

Nonsurgical Skin Tightening

SUMMARY AND KEY FEATURES Nonsurgical skin tightening is a popular concept, with novel devices continually entering the market. The main types of nonsurgical skin-tightening technologies include radiofrequency, infrared light, ultrasound, microneedling with radiofrequency, and subdermal minimally-invasive radiofrequency. Treatment protocols have evolved over the years to focus on reduced energy settings and multipass techniques, making the procedures safer and more comfortable for patients. All skin-tightening devices work…

Nonablative Fractional Laser Skin Rejuvenation

Summary and Key Features Nonablative fractional resurfacing (NAFR) is a safe and effective treatment that has become the cornerstone for facial rejuvenation and acne scarring. It is effective in treating a variety of conditions, including scarring, mild-to-moderate photoaging, and some forms of dyspigmentation. Nonablative fractional photothermolysis has minimal downtime with almost no restrictions on activity immediately following treatment. Erythema and edema are common sequelae after treatment…

Treatment of Skin With Intense Pulsed Light Sources

SUMMARY AND KEY FEATURES Intense pulsed light (IPL) devices are highly versatile and can be used for a wide range of esthetic and medical conditions. IPL platforms use high-output flash-lamps to produce polychromatic, noncollimated, incoherent (nonlaser) light, with wavelengths ranging from 500 to 1400 nm. Benign pigmented lesions, dyschromia, unwanted hair, telangiectasias, facial redness, flushing, Poikiloderma of Civatte, precancerous lesions, and acne can all be effectively…

Laser Hair Removal

Summary and Key Features Laser hair removal (LHR) is the most commonly requested cosmetic procedure in the world. The ideal candidate for LHR is fair skinned with dark terminal hair; however, LHR can currently be successfully performed in all skin types. Thin hairs and hairs with white, blond, and red color are extremely difficult to treat with LHR devices. Wax epilation should be avoided prior to…

Laser Treatment of Pigmented Lesions and Tattoos

Summary and Key Features Advances in pigment-specific lasers have allowed for the safe and effective treatment of various benign pigmented lesions and tattoos. Picosecond (PS) lasers are the newest additions with current studies suggesting a superior efficacy and safety profile for treating pigmented lesions and tattoos compared with nanosecond domain quality-switched (QS) lasers. The pigment-specific lasers most commonly used for benign pigmented lesions and tattoos include…

Laser Treatment of Vascular Lesions

Summary and Key Features Vascular lesions are among the most common indications for laser treatment. Treatment relies on the theory of selective photothermolysis and aims to confine thermal injury to targeted vessels. Pulsed dye laser (PDL) is the treatment of choice for port-wine birthmarks (PWBs), but multiple vascular targeting devices can be used. Early treatment is thought to enhance response. Resistant or hypertrophic lesions can be…

Understanding Lasers, Light Sources, and Other Energy-Based Technology

Summary and Key Features Laser is an acronym that stands for Light Amplification by Stimulated Emission of Radiation. Laser light is a concentrated beam of electromagnetic radiation that travels at a single wavelength. The therapeutic value of a laser rests on the principle that specific compounds in the skin (chromophores) absorb laser light more readily at specific wavelengths. This process is known as selective photothermolysis. The…

Devices and genomic therapies

Key points Using clustered, regularly interspaced, short palindromic repeats-CRISPR associated protein 9, hair follicles with high steroid type II 5α-reductase enzyme activity can be genetically altered into follicles with suppressed SRD5A2 enzyme activity, theoretically allowing hair follicles to grow new hairs for a lifetime, without side effects. High-efficiency delivery of therapeutic proteins and genetic elements to target cells in the hair follicle is achieved with cutting-edge…

Emerging medications

Key points Topical prostaglandin analogs may increase vellus and terminal hair density and stimulate hair follicle activity. Janus kinase inhibitors demonstrate great success in the treatment of alopecia areata, with potential for androgenetic alopecia. Therapies targeting growth-factor regulation offer innovative options with success in androgenetic alopecia. Antiandrogen therapy has a long history of investigation for therapeutic use androgenetic alopecia, and new topical therapies show promise. Topical…

Lasers, lights, and leds

Key points Several laser and light-based therapies, including low-level laser/light therapy, excimer laser, monochromatic excimer light, narrowband ultraviolet B phototherapy, and fractional laser, have been studied for the treatment of androgenetic alopecia. Most research has focused on low-level laser/light therapy, also known as photobiomodulation. Evidence for other energy-based modalities is limited. There are a variety of low-level laser/light therapy devices cleared by the U.S. Food and…

Hair transplantation

Key points Hair transplantation consistently creates natural-appearing hair for men and women with hair loss. Indications for hair transplantation include male and female pattern hair loss, inactive inflammatory scalp dermatoses, and reconstruction of hairlines lost to trauma or surgery. Realistic expectations of what hair transplant can and cannot achieve is key to patient satisfaction. Successful combination treatment with medical therapy allows the greatest long-term density, as…

Stem cell–based therapies

Key points Stem cells are a potential therapeutic option for the treatment of androgenetic alopecia and other forms of hair loss. However, serious adverse events have been previously reported from the use of stem cells for non dermatologic applications. As such, stem cell therapy is subject to strict regulation by the US Food and Drug Administration. Adipose tissue is a readily accessible and abundant source of…

Platelet-rich plasma

Key points Androgenetic alopecia is the most common form of hair loss and is characterized by progressive reduction and miniaturization of terminal hair follicles on the scalp. Although androgenetic alopecia is benign in nature and often considered part of the normal aging process, it is a familiar cosmetic concern encountered by dermatologists, as it negatively affects patient quality of life. Developing a therapeutic regimen for patients…

Complementary and alternative medicine for hair loss

Key points Patients with androgenetic alopecia may be interested in exploring complementary and alternative medicine, including supplements, specialty diets, and essential oils. There is insufficient evidence to support the use of any complementary and alternative medicine as monotherapy for androgenetic alopecia. Patients who wish to forgo traditional therapies in favor of complementary and alternative medicine should be counseled that the latter are not considered an appropriate…

Systemic immunotherapies

Key points The role of inflammation, including T cells, mast cells, prostaglandins, and cytokines, in the pathogenesis of androgenetic alopecia has been studied. Different approaches to address this inflammation have been recommended. Use of anti-inflammatory immunotherapy in androgenetic alopecia is primarily through topical treatment; systemic immunotherapy is rarely prescribed. When treated with systemic immunotherapy, patients who have both androgenetic alopecia and alopecia areata typically experience regrowth…

Topical immunotherapies

Key points Androgenetic alopecia is the most common cause of hair loss and arises from androgen-dependent hair follicle miniaturization on the scalp. Several studies have suggested that follicular microinflammation is implicated in the pathogenesis of androgenetic alopecia, but to date, no immune modulatory therapies have been investigated for use in androgenetic alopecia alone. Androgenetic alopecia can arise in the setting of other forms of alopecia such…

Minoxidil, finasteride, and dutasteride

Key points Androgenetic alopecia is the most common cause of alopecia in both men and women; however, approved therapeutic treatment options are limited. Patients should be counseled that treatment of androgenetic alopecia is directed toward prevention of further hair thinning and loss, as complete hair regrowth may not be achieved. Topical minoxidil is an Food and Drug Administration–approved, first line treatment for androgenetic alopecia in both…

Micropigmentation and microblading

Key points Androgenetic alopecia is a frequent cause of hair loss and hair thinning for both men and women, and it has the potential to negatively affect self-esteem, psychosocial functioning, and quality of life. Micropigmentation, also known as medical tattooing or dermatography, conveys the aesthetic use of tattooing for medical purposes. , Scalp micropigmentation is a cosmetic procedure used as a concealer to address hair loss…

Wigs and hair prosthetics

Key points Patients with androgenetic alopecia and other types of alopecia may turn to hair prosthetics when other medical and procedural interventions have been aesthetically unsatisfying and hair loss negatively affects their quality of life. When recommending a wig style to a patient, it is important to consider the patient’s face shape, lifestyle, goals, and environment. Wigs and hair prosthetics should be considered important therapeutic treatment…